Breast Reconstruction: New Procedure Spares Abdominal Muscle

A strong family history of breast cancer led Irina Figo to make a difficult decision. In a 15 hour surgery, she had both breasts removed - and a new procedure to reconstruct them.

"It seemed very natural to use your own tissue, rather than an implant," says Irina, who had the procedure several months ago. "I've been very happy with the decision."

The reconstructive procedure, called
DIEP Flap, or Deep Inferior Epigastric Perforator Flap, uses skin, tissue and tiny blood vessels taken from the abdomen to form a new breast. But unlike traditional procedures, the DIEP Flap spares abdominal muscle.

"The idea of using abdominal tissue for breast reconstruction has evolved over the past 20 years," says
Dr. Samuel Lin, a plastic reconstructive surgeon at
Beth Israel Deaconess Medical Center who specializes in the DIEP Flap procedure. "The goal is to take no muscle at all, leaving the abdominal region as whole as possible. This means a potentially faster recovery for women to return to their physically active lifestyles."

Other surgical reconstructive methods involve taking tissue from the tummy, back, and buttocks. But Dr. Lin believes the tissue in the abdomen is most like breast tissue. Sparing the muscle while sectioning out the appropriate blood vessels does mean a longer, more intricate procedure in the operating room, says Dr. Lin.

"It takes more time - for one breast, about six to eight hours," says Dr. Lin, adding that the abdominal scar is similar to the scar for those who have a tummy tuck. "The surgeon must have great attention to detail to take only what is needed and then be able to connect the vessels using a microscope appropriately to create and shape a new breast."

In the past several years, more than 750 DIEP Flaps have been performed at BIDMC, more than any other hospital in Boston.

Not every woman is a candidate for DIEP Flap, however. Women who have had a lot of abdominal surgery, those who are really thin and don't have enough tissue to form a breast, or those who are obese may not appropriate for the procedure. Also, those who have co-existing medical issues should be carefully evaluated before having the surgery, he says.

As with any surgery, possible complications include bleeding and infection. There is also a small chance the tissue will not heal properly and as with any abdominal surgery, Dr. Lin says, there's a risk of developing a small bulge or hernia.

"Women undergoing mastectomy have options - from silicone and saline implants to reconstructive surgery," says Dr. Lin. "Each woman needs to review the benefits and risks with her plastic surgeon and make the choice that's right for them."

Unfortunately, not all women are familiar with all the options. A survey of 1,200 early stage breast cancer patients published in 2007 in the Journal of the American Cancer Society found only one out of three said they had talked with their doctor about plastic surgery options, in the event it might be needed. Breast reconstruction can be done at the same time as mastectomy or even in a delayed fashion, several years later.

Irina learned about DIEP Flap from a friend who also had it done.

"Lots of women probably don't know about this [technique]," she says, urging women to research all their options. "For me, this was a good choice. It feels natural and it looks natural."